Cypress Internal Medicine Blog

In April, I will be leaving for a medical mission trip to Kenya for 10 days. This is a journey years in the making but truly the highlight of many years of hard work. I have been to South Africa on a medical mission trip before and have been excited to return to Africa. However, now as an attending have deferred this travel as I wanted to make sure I could carry the load, do a good job and meet a need to the best of my ability. I was unprepared to go to Kenya this year, I had not been preparing both physically, emotionally or financially for this journey I am about to embark on, but many peices to this puzzle fell into place for this to happen and I need to go, I need to serve, I need to give of myself and help others when I can.

This was not an easy decision for me, I am missing the highlights of many pivotal moments in my little girls life. Missing her dance recital, her 5th birthday and even the Daddy-Daughter dance has my stomach uneasy as a mother. I will miss my husband, I am thankful for his committment to me and my family and for pushing me to go and give of myself outside of my comfort zone. I will miss my little boys, my big boy – missing ball games and how in the world will his homework get turned in, boy scout outfit put on correctly, back pack ready each morning and making sure he actually brushes his teeth and uses soap in the shower. And then my little man – who is in the middle of potty training. How can I leave his sweet face, getting all his stuffed animals tucked in at night and missing the loves and kisses in the morning.I am going to miss my family so much!!

I am going to miss the office, miss my patients. Leaving for ten days and placing that responsibility upon my partners, however what a blessing it is to work with such wonderful women, who support me. It is so peaceful to know that my patients will be well cared for, that they want me to go and serve and that I have their support 100%.

But with all of this, knowing my family is safely in the arms of their wonderful father and knowing my patients are safely in the arms of my partners, I must go. I want you to join me on this journey. I want you to understand the need for medical missions and for service in these countries but also want for you to leave this series of blogs feeling blessed. Blessed in your life and blessed with the medical care we are offered in the United States. Blessed with the resources that are accessible to us. We are so rich in America, no matter how poor financially you are, it does not compare to those in Karatina and hopefully for many of you who struggle with insecurities, depression, pity may you find hope and restoration in reading about those whose even physical needs are not met on a regular basis.

A little about where this journey is going to take us. I am heading to Kenya, the town Karatina. The name Karatina is a diminutive term for Muratina – the name of a squash/courgette tree. The town was founded before the British Colonization of Kenya by Gikuyu women who used to trade their crafts and food under a courgette (muratina) tree. Women would direct each other on where to sell or buy merchandise under the Karatina. It is a farming and trading town in Nyeri County of Kenya’s Central Province. It lies on the main Nairobi –Nyeri/Nanyuki road. It has one of the biggest open air markets in Africa managed by the towns’ county council.

This area of service is one of several that our church has served in Kenya, and this location is a little more industrialized than some of the villages they have served in before. I would love to know questions that you may have, concerns as well. If you have ever wondered about what we are planning to do and how we do it logistically, please dont hesitate to ask. Our team is in the process of preparing for this trip, obtaining vaccincations for Africa, collecting medications and supplies and for the ladies figuring out how to pack 10 days of wardrobe into a small back pack on your back so that your suit cases can be full of supplies.

Today was a day like any other except it was the day I was to have a lump in my breast evaluated. I am not used to being the patient, I am the one who completes the exam, orders the test, reviews the results and discusses the outcome with the patient. This was a different side of the lense, one that made me slightly uncomfortable.

Two weeks ago I found the breast mass, it was something I did not want to make a big deal of. I mean my family history is negative for breast cancer and lots of family members have fibrocystic breast disease. I reviewed in my mind all the possible outcomes but after a week or two of it not resolving I felt it was time for further evaluation.

Today, I went to obtain a diagnostic mammogram and ultrasound. My experience at the Patewood Campus of the Greenville Health System was a very pleasant one. This was great to experience for myself as I have many patients that go there to obtain their testing. I had no wait time, was escorted back quickly and was greeted by extremely nice technicians. The ladies were exceptionally calm, and patient as this was the first time I had had a mammogram. It was quiet, calm, professional. The procedures were not painful, a little uncomfortable however, but I wanted to obtain a good reading so was happy to accomodate . I obtained results within minutes from the radiologist and am relieved to say that it did not look suspicious for malignancy.

After this experience, I have learned many things. The most important is that breast exams are important, you can find lumps and breast abnormalities and you can have them evaluated in a very simple, efficient, and effective way. Second, I have a better perspective of what my patients experience when I ask them to obtain their yearly mammogram. Finally, illness and disease are scary things, especially when it is yourself and I will never forget the moment I became the patient and what that felt like.

The month of November and especially this past week have been full of opportunities for us to reflect upon what we are thankful for. Scanning your facebook, twitter, and email accounts, you have probably read the postings of many friends about how they are making an effort to think about and name the many blessings we have all been given. Some of the truly dedicated even managed to do this everyday in the month of November. I have done the same, but I think our thankfulness has to go so much farther than a daily social media update. If we all agree that we are truly blessed, what are we going to do about it? Our thankfulness needs to translate into something tangible that we can do to impact each other and therefore, our community.

As the Christmas season is now upon us, it is even more important to continue to focus on our blessings, but also take a step farther and use our time, talents, and finances to serve those around us. My husband and I have spent time talking to our kids about what it means to truly serve others and as a family we have participated in some activities of service so far this year and will continue to do so. On November 19th, our church had an event they called Servefest where more than 1300 people signed up to do various service projects around the community. My family and I participated together and the lesson my kids learned was invaluable. Serving others is not always convenient and sometimes it is not what we want to do early on a Saturday morning, but it is so very important. We also put together shoeboxes for Operation Christmas Child that are sent to children who would otherwise not have a Christmas gift. There are several other things we are planning to do this month and I am sure there are many service opportunities available in your community as well. While these things may seem very simple, their lesson can be profound.

Now I personally love to give gifts, so I will certainly be buying Christmas presents for my children, family, and friends. But this year, even moreso than previous years, I will not stop there. My family and I will spend time talking about what we can do for others and follow that up with actual acts of service. I want to be a model for my kids and for those around me that Christmas is not just about making long lists of things we think we cannot live without. I will use the blessings that I have been given to impact others and in doing so, will teach my children to do the same. During the Christmas season and throughout the year, it is truly better to give than to receive.

I challenge each of you to look around you this Christmas season and find something you can do, big or small, to serve others.

My nephew who is 4 years old was recently diagnosed with a heart murmur. My sister called to tell me she had been referred to a pediatric cardiologist. I told her not to worry, no big deal, they will do an echo and I am sure everything will be fine. I never thought she would call me in tears telling me Cooper needed open heart surgery to repair a heart defect. I think we were both overwhelmed at the news. Honestly I thought my Dad’s death was the one tragedy our family had gone through so we were good, right? But I couldn’t help thinking that something really bad was going to happen to Cooper. I read about the treatment in children, zero percent mortality, all of this should have been reassuring. We even sent his echo to a friend at Vanderbilt who recommended the same treatment. I was very impressed by my sister’s reaction, she said “Well, at least we can do something about it” and she did it. She dealt with every thing as it came and was a wonderful mother, nurse and coach to Cooper.

I went to stay with my sister during the surgery. Leaving Kyle with a lot of responsibility. Reminding myself that if Sarah and William don’t eat a vegetable for 3 days it won’t kill them. It’s hard to be a caretaker when you have small children. I felt the same when my father was dying. Thinking my child should be 16 years old not six weeks old.

We sat in the surgery waiting room for hours. They were very good about keeping us updated – every hour we heard something. I can’t imagine how my sister felt to have Cooper out of her arms for that long. When they told us the surgery was over, Cooper was fine, the doctor would be there to talk to us in just a minute she and her husband embraced, in tears. I almost felt it was too private of a moment to witness. We were able to see Cooper about 2 hours later, in the ICU, on a breathing machine, tubes everywhere. Later, while mommy and daddy were taking a much needed break, he asked me not to leave his side, he wanted to close his eyes and open them to see me when he woke up. I thought to myself no problem, I’ll stand here for eternity. Reminding me of my med student days standing and holding a retractor during a nine hour surgery, this was a piece of cake. He continued to improve rapidly and was out of the hospital in 3 days! Unbelievable. He was a trooper and I told him he was a super hero. Now he lifts up his shirt, points to his scar and says “open heart surgery”.

I think when you have been given any diagnosis you assume that the worst is going to happen, you feel overwhelmed. Whether it is a chronic illness such as diabetes, an elective surgery or even when we hear the scariest news like cancer. The first step is to learn more about what you are facing, get support from family members, and then deal with the issue day by day. Whom ever you share this with will probably feel the same way I did, honored to be a part of my sister and her husband’s life in this way and happy to have these memories with my nephew. I am so proud of my sister who was brave enough to accept what she had been told.

What is the appropriate age to let a child have his or her own cellphone? I don’t know the right answer to this question. I do know one of the wrong answers however, and that is “when all of her friends have one”. The issue however, is a complex one. Many children are likely quite capable of handling their cellphones responsibly, even at a young age. Others however, may never learn this skill.

Let’s talk about technology etiquette for a minute. I have heard stories of teens texting their backseat passengers while they are driving. Texting while driving carries the same risk as driving drunk. Not only is it dangerous, but come on, what is the point? I see groups of kids out on Friday nights, sitting in a circle at Starbuck’s, texting and emailing each other and not speaking a word. Again, what is the point? Many of the college-age students in my internal medicine practice not only can’t put their smartphones on silence while in my office, they can’t stop texting and looking at those handheld screens for the 10 minutes they are seeing me in the exam room! Not only is this counter-productive, it is just downright rude. How are they ever going to handle a job, or even a job interview if they are so addicted to their smartphone and the mindless chatter.

This has to be damaging to social development. Eye contact, body language, and intonation are important social cues that have to be learned through practice. Will these be lost on the generation born after the millennium? What about those of us in the medical field who depend on our computers 100% for all of our information? Will this new generation have the finesse to read into their patients’ lives, or will they keep their noses in their laptops and forget that their is a live person in the room?

Unfortunately, I have no answers to any of these questions, but the trend away from non-verbal internpersonal communication is disturbing to me. I suppose people living in the 1950s said the same thing at the dawn of the television era. Admittedly, I love the convenience of my iphone and enjoy having a few moments alone every day with my ipad, but what happens when I want to take a break and step away from all the tech? I tried to cancel my Facebook account the other day–after several attempts, I realized it was fruitless. They have me in their system and they (whoever “they” are) aren’t letting go.

Back to the question about when to let a child have a cellphone. We have seen such an explosion of technology in the last few years. Just think, five years ago, there were no smartphones, ipads or droids; no facebook, twitter or you-tube. It is tempting to extend these priveleges to our children, especially since they are much more tech-savvy than we are. However, I think about how the world will have my child’s attention all too soon, so for me, I am going to hold off on the phone/email/texting/facebook with my kids as long as I can.

Oh the joys of having little children in daycare! My little ones were home sick this past weekend with a GI bug and thankfully quickly got over their illnesses. I, on the other hand, caught their bug and was in bed for 24 hours hoping and praying I would feel better soon! I rarely get sick (I better knock on some wood!) and catching this most recent bout of daycare germs made me take a moment to reflect and be thankful for good health and a healthy immune system. I think most of us probably take being healthy for granted, I know I do. We just assume we will always be healthy, almost that “I am invincible” mentality that most teenagers have. Unfortunately as we age we must realize that staying healthy does take some effort, whether that means eating right to keep our immune systems healthy, getting enough sleep at night, emotionally and mentally recharging our batteries (as Dr. Renfrow wrote about last week) or exercising. We need to find the right combination of these things that keep our lives and our bodies in balance.

Being sick is no fun, but also with the crazy lives we lead with multiple commitments, family needs and personal needs, we just don’t have the time to be sick! I made a pact with myself that I would try to be healthier by incorporating a more healthful diet into my busy schedule as well as carve out some time for exercising. We need to also make sure we are doing those preventative things to keep from getting sick. I think that the most obvious preventative thing this time of year is getting the flu shot. This is important not only to keep ourselves from getting the flu, but also those around us that we love. I know, I can hear some of you now (my husband included) that the flu shot “makes me sick; doesn’t work; I have never gotten the vaccine and never gotten the flu so why should I start now….” The endless reasons we talk ourselves out of getting something that may prevent disease in the future. Please put all those excuses aside and consider getting yours this season to keep you healthy!

We never know what bugs we are going to pick up around us but we do know how we can make ourselves as strong as possible to keep us healthy. We want you to be as healthy as possible on this journey of life and hope that you will make the commitment to leading a healthy life!

I am sitting here in beautiful Murrells Inslet, South Carolina. It is a small creek town on the water way where I really grew to know nd fall in love with my grandfather. This was not his hometownn but where he went to get away from it all. This place was his respite. A quiet, peaceful hiding place where he could go and rejuvenate, renew, recharge. It was in these waters, he would spend hours in his Boston Whaler, hours putting in crab traps, flounder gigging, meeting new friends, docking a restaraunt in the inslet to have a good meal. My grandfather was an amazing man, much of who I have become today is owed to him. It is tonight, in this place I sit thinking of how important it is to have time to slow down and rejuvenate.

We all live busy lives, many of us are working moms and many are stay at home moms. Either way, the responsibilities and work load is great and the time is little. We often get bogged down , overwhelmed, over stimulated in this world we live in. Do this, do that, be here, drop this child off, run this errand, deadlines, homework, dinners, cleaning…..it will never end…..

We have the choice to embrace this life and have the choice to say to ourselves, we are blessed to be busy…..at the same time we have the choice to let it get the best of us, to let these responsibilities overwhelm us. When this happens many of you, instead of taking a moment to breathe and regain composure, find themselves frustrated, irritable and overwhelmed. Our children take the brunt of this as well as our spouses. Our spouses who may be equally stressed and overwhelmed, often get pushed to the back burner and this cycle begins to put a strain on your marriage. (and I might add libido)

You come in to see me, at your wits end, ready to give up and you feel all hope is lost. I want to encourage you that in this life you have been given you need to know it is a gift and a blessing, no matter the pain and one that you can tackle and handle. There are times when many of you may need medications to treat your pain, your feelings of anxieties and depression around certain situations but more often than not what you need is to be surrounded but women in your lives who surround you with support, open ears, positive attitudes and women who can relate to what you are going through. Community that can comfort you in times of need but also remind you that they are likely struggling with the same situations and that with each other you can lend support. I can not express to you the power of community. I also can not tell you the power of counseling. Sometimes it just helps to have an unbiased third party perspective of what is going on in your life to let you know what steps or direction to take with to take. I am a firm believer in the power of counseling.

All of this to say….my grandfather taught me so many lessons. But the one lesson of this night, in this moment is to work hard and play hard. You have to find time in your busy life to rejuvenate, to spend quality time with each of your children and especially my husband. It does not have to be in Murrells Inslet, but even that simple quiet bath time at night, or the quiet time alone in the morning, use it to remind yourself that sometimes we choose how busy we are and maybe we can readjust that. We may can choose to have less going on, less activities and more time with our spouse to actually fall in love again and with his support maybe you won’t feel so alone and overwhelmed.

Today as I entered one of my patient rooms, I was immediately faced with an older lady who had been crying and was obviously not doing well. As I asked her what was going on, she told me that her husband had suddenly died about a month ago from a massive heart attack and she was having a very difficult time adjusting to her new life. As I sat down next to her and put my hand on her shoulder, I listened to her story about what had happened to her husband and the things she has been dealing with since that time.

So many times, I am called on to know the right diagnosis, what to say, how to say it, what tests to order, and what medication should be given to address a particular problem. Those of us in the medical field often get so accustomed to fixing things that it can become very hard when we cannot fix the problem. This is obviously not because we do not want to fix it, but many things we face are out of our control.

Today, I am again faced with the fact that all of the medical knowledge and schooling do not offer much help in a time of emotional crisis for a patient. What my precious patient needed today was someone who would listen, even for just a few minutes and take the time to truly care about what she had to say and how she was feeling. I could offer little advice, and certainly could not do anything to bring her husband back, but most importantly, what I did for her today made a difference in her life because I listened.

Too often we are in such a rush that we forget how important it is to stop and take the time to listen. Though I know my medical training provided me with many valuable skills, I never want to forget how important a listening ear and a sympathetic heart can be. I pray that today, my patient left encouraged and able to continue on without her companion for life. For me, I know that I am a better person because I took the time to listen to her. Medicine can never substitute a listening ear.

Making the transition from residency to private practice has been fun, scary, exciting and sometimes a bit overwhelming. A few short months ago I was a “resident” meaning I had an “attending” physician who I could call at any time to ask a question or run a treatment plan past. Now, I am the attending! When I started medical school this time seemed so far away. I remember thinking so many times during residency how I couldn’t wait to be out and on my own. Now that I am in the “real world” of medicine I find myself really enjoying having my own patients but I must admit it can be a little scary being the person in charge of someone else’s health and well-being. What a great privilege and responsibility to care for so many! I must say thank you to my partners who have been ever so gracious to help guide me through the world of insurance, paperwork, obscure diagnoses and more paperwork! It has been a great month so far and I am so looking forward to many years of practicing medicine.